Prone transradial approach for radiofrequency ablation of hepatocellular carcinoma in the caudate lobe following TACE: a technical case report

Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) located in the caudate lobe is technically challenging because of the tumor's deep location and proximity to major vascular structures. A 71-year-old woman with a 2-cm HCC in segment I underwent conventional transcatheter arterial chemoembolization (TACE) via the femoral artery. Immediate RFA was not feasible because CT arterial portography revealed no safe puncture route due to surrounding vasculature. On the following day, angiography using a left transradial approach was performed with the patient in the prone position, enabling identification of a safe dorsal puncture path. After creation of an artificial pneumothorax, percutaneous CT-guided RFA was successfully completed without complications. Prone transradial angiography can facilitate safe RFA for hepatic tumors in anatomically challenging locations such as the caudate lobe. This approach may broaden treatment options when conventional supine access is not possible.